A few issues have resulted from the 2004 Workers’ Compensation Reform package from Senate Bill 899. Although the creation of Medical Provider Networks (MPNs) has allowed employers to have better control over treatment for injured workers, employers are concerned that these employees are being given permission to get medical care outside of their MPN. These regulatory breaches are defeating the purpose of SB 899.
Additionally, injured workers are frustrated when they have difficulty scheduling appointments with MPN physicians. Many MPN lists contain physicians who are no longer available or who refuse to treat industrial injuries.
There are minimal changes proposed for applicants in SB 863. It suggests that an entity that provides physician network services can now also apply to be an MPN applicant.
For established MPNs, substantial changes were suggested.
Administrative oversight changes would include:
It remains to be seen whether the amendments made to the MPN process by SB 863 will alleviate the issues created from SB 899. However, the WCAB has been quite rigorous in reversing judges who fail to adhere to the new requirement that a violation in MPN regulation must result in a “denial of medical care” in order to allow the injured worker to seek medical care outside of an employer’s MPN.
You can find the comprehensive regulations for MPN’s in Title 8, California Code of Regulations, sections 9767.1 – 9767.16.
If you have questions about SB 863, please contact the Division of Workers’ Compensation (DWC) with the California Department of Industrial Relations, please review their FAQs page or email them at firstname.lastname@example.org.